A peculiar civilisation is one in which a village can be short of one doctor and somehow conclude, after ten minutes of perfectly respectable conversation, that what really needs to happen first is a change of government.
One should admire the scale of the ambition. A child in Darfield cannot get an appointment, therefore Cabinet must fall, Treasury must revise its assumptions, Health New Zealand must alter its workforce settings, immigration policy must be recalibrated, universities must train more doctors, the fiscal envelope must move, perhaps neoliberalism itself must be reconsidered, and then, after this majestic procession of historical forces has completed its work, one doctor may eventually arrive with a stethoscope and ask where the consulting room is. This is rather like noticing the kitchen tap is leaking and saying, yes, but before we do anything rash we really need a national conversation about water.
Leopold Kohr, who spent much of his intellectual life warning that our problems become monstrous simply because we permit institutions to become monstrous, would have recognised the comedy immediately. For Kohr the question was not always whether the institution had the wrong ideology, the wrong personnel or the wrong manifesto. Sometimes the thing was simply too big. Once systems become too large, cause and consequence drift apart, responsibility becomes foggy, people begin talking in categories instead of names, and the ordinary citizen develops the strange habit of standing beside an obvious problem while looking over the horizon for somebody authorised to solve it.
We normally think centralisation means Wellington accumulates power, but Kohr allows a nastier interpretation: Wellington also accumulates problems. Every difficulty packs a little suitcase and travels upward. The doctor shortage goes to Wellington. The bridge goes to Wellington. The school problem goes to the ministry. The bus goes to the region. The water pipe goes to the council. The playground goes into the Long Term Plan. The dangerous corner is placed in a transport strategy. The local hall roof gets an asset number and enters a renewal programme. By the time the problem returns home it may have acquired a business case, a consultation phase, a stakeholder map and several people with lanyards, but it has often lost the one thing it possessed at the start, namely someone who regards it as his problem and feels slightly embarrassed that it remains unsolved. Kohr's point, and it is more moral than administrative, is that scale changes the texture of responsibility. In a village, if the roof leaks, everyone eventually knows who said he would bring the ladder. In a large institution nobody fails to fix the roof. The matter is prioritised according to framework. This is much cleverer than corruption because corruption at least gives us a villain. Large systems give us distributed innocence. One person has policy responsibility, another has budget responsibility, another has delivery responsibility, another has procurement authority, somebody monitors outcomes, the minister is politically accountable but must not interfere operationally, the chief executive is operationally accountable but cannot change the appropriation, the council sympathises but says the matter is outside jurisdiction, the community is thanked for its valuable feedback, and under this magnificent cathedral of responsibility one old woman still cannot see a doctor.
Pressman and Wildavsky understood this wonderfully in their study of implementation. Policy does not travel from intention to outcome like water through a pipe. It goes through doors, each with a lock, and each lock belongs to somebody else. Every approval point, every agency, every condition, every handover is another chance for the thing to be delayed, diluted, misunderstood or quietly buried. What is comic is that when ordinary citizens encounter a local problem we often respond by voluntarily adding more doors. We say the town needs another GP, therefore what we need is a workforce strategy; the workforce strategy requires money; the money requires Budget priority; Budget priority requires political support; political support may require electoral change; electoral change requires waiting; then coalition talks; then a ministerial programme; then officials; then consultation; then implementation. We have taken one missing doctor and converted him into the constitutional crisis of a medium-sized European kingdom, and we call this seriousness. Kohr would simply say the thing has become too large for human beings to feel where their hands should go.
Albert Hirschman would be useful at precisely this point because he distrusted this taste for complete explanation before incomplete action. His “possibilism” was a refusal of the idea that we must understand the whole machine before touching one lever. He would ask the irritating questions. Why precisely can we not attract one doctor? Is it salary? Housing? Registration? Professional isolation? After-hours duties? The spouse cannot find work? The practice model is unattractive? The visa is uncertain? The town has no decent rental accommodation? Which one of these is actually stopping someone signing the contract? This is not glamorous politics. It is almost indecently practical. Herbert Simon would make it worse by decomposing the problem. Simon's bounded rationality begins from the obvious but continually ignored fact that nobody understands the whole system, certainly not enough to optimise it. So stop pretending. Break the thing apart. “Rural health crisis” sounds large enough to justify despair. “Doctor cannot be recruited because accommodation and after-hours burden make the package unattractive” sounds like something somebody might have to do something about. And once the problem is decomposed, responsibility becomes more uncomfortable because it acquires names, amounts, dates, phone numbers. The enormous crisis that permitted everyone to have an opinion becomes a list of jobs, and human beings have always preferred metaphysics to lists of jobs.
Charles Lindblom called this “muddling through”, one of the least marketable phrases ever offered to politics, but perhaps one of the most intelligent. No party launches a campaign beneath a banner saying WE WILL MUDDLE THROUGH MORE COMPETENTLY, although that may describe much of successful government. Lindblom's argument was simply that in a complicated world we often proceed through limited comparisons, small adjustments, observation, correction. Engineers live in this universe without finding it humiliating. A structure develops a problem, you inspect it, understand the likely mechanism, test, strengthen, monitor. You do not refuse to shore up a cracked beam because the profession has not yet settled the philosophical question of concrete. Politics, however, has learned to use structural causation as an excuse for structural delay. Karl Popper had the same instinct when he defended piecemeal social engineering. Find an identifiable harm, intervene, watch what happens, correct the intervention. It sounds small only because modern politics has confused verbal scale with moral seriousness. “Transforming primary care for future generations” sounds grand. Getting one additional doctor into one town sounds embarrassingly parochial. The family who finally gets an appointment may not share this hierarchy of grandeur.
Michael Oakeshott enters here from a different door. His attack on Rationalism was really an attack on the conceit that practical life should begin with an explicit theory and only then descend into action. Oakeshott thought politics was closer to navigation. You do not necessarily know the final destination in some absolute sense. You know where you are, what conditions you face, where the rocks are, and what the next competent move might be. “Where do we go next?” is a devastating political question because it is so much less impressive than “what should the health system look like in 2040?” It has no orchestra behind it. It asks what happens Monday morning. Who calls whom? What document is needed? What obstacle can be moved? This feels anti-intellectual only because we have developed the bad habit of regarding abstraction as intelligence and practical sequencing as clerical work. James C. Scott would then ask us to notice how differently the world looks depending on altitude. From Wellington, a district may look adequately serviced because the FTE ratios fall within some expected range. From the town, three practices may have closed their books and everybody knows which receptionist keeps having to tell frightened parents there are no enrolments. The state needs categories because large systems cannot function without simplification. Scott's point was not that categories are lies. It was that categories become dangerous when they acquire monopoly rights over reality. The spreadsheet says service coverage. The local person says, “I rang three times and cannot get in.” The first is regarded as data, the second as anecdote. Yet the anecdote is often the thing that actually happened.
Scott's idea of mētis, practical situated knowledge, cuts straight across the administrative instinct to wait for validation. The pharmacist knows what is happening. The teacher knows which families are struggling. The receptionist knows which callers are desperate. The local employer knows why a professional's partner would not stay. The residents know whether the official travel time is realistic in winter. None of this knowledge arrives with a logo. This is precisely why large institutions often distrust it. Elinor Ostrom then provides the antidote to the false choice that says either the state solves the problem or we descend into amateur village chaos. Ostrom spent decades showing that complex collective problems can be handled through multiple overlapping centres of action. Polycentricity is a horrible word for a rather ordinary human idea: different people can do different parts. A medical practice can do one part, the community another, Health New Zealand another, immigration another, local employers another, perhaps philanthropy another, perhaps council another. Nobody needs to become sovereign. The bureaucratic mind dislikes this because it looks untidy, and modern bureaucracy is deeply attracted to the clean organisational chart in which every problem has one box, one owner, one reporting line, one accountable manager. Reality, unfortunately, is not a PowerPoint slide.
This is why the phrase “that's the government's job” deserves more suspicion than it usually gets. Sometimes it is perfectly true. Governments possess powers communities do not. They tax, regulate, issue visas, fund major systems, enforce standards. Nobody sensible wants a residents' association licensing surgeons. But the phrase often does something else at the same time. It closes the psychological file. Erich Fromm would recognise this instantly. Freedom is burdensome because freedom means responsibility and responsibility means the possibility that your effort will fail. It is much safer to send the problem upward. If Wellington fails, Wellington is incompetent. If we try and fail, we may discover that our plan was stupid. Dependence and resentment therefore become strange companions. One can despise the state continuously while entrusting more and more to it. The citizen complains that Wellington controls everything, and then every time something goes wrong he asks Wellington to take control. This is the politics of adolescence. Mother is unbearable, Mother understands nothing, Mother is ruining my life, and also can Mother please fix this.
Jacques Ellul adds another layer because his idea of technique describes a world in which more and more of life is handed over to systems, experts, methods, procedures, certification. Again, much of this is reasonable. Expertise exists for a reason. But once a society becomes saturated with technique the ordinary person begins to lose confidence not only in his capacity to solve problems but even in his right to define them. He starts saying, “Surely someone qualified should deal with this,” and quite soon only authorised actors are permitted to identify the issue, frame the issue, gather evidence about the issue, consult stakeholders on the issue, and ultimately manage the issue. Foucault would enjoy the subtlety of this because no policeman is required. Power works by shaping the categories through which the citizen understands legitimate action. You are encouraged to have a view. You may submit. You may be heard. You may attend a workshop and place a coloured sticker on a wall. But actual initiative begins to feel slightly improper, as though you are trespassing on somebody's mandate. Thus we construct the curious democratic citizen who is constantly “engaged” and increasingly convinced that the important work belongs to somebody with an office.
Weber's ethic of responsibility is almost brutally simple beside all this. It asks what your action can actually produce. Conviction is easy. Everybody agrees rural people should have decent access to healthcare. Fine. Wonderful. Applause. Weber then ruins the atmosphere by asking who is doing what next Tuesday. This is where politics becomes less theatrical and much more difficult. You need names, numbers, relationships, compromises, follow-up, patience, possibly a person you dislike, perhaps a meeting that achieves nothing, then another one, then a letter, then some money, then a doctor who changes his mind, then another doctor, then finally something works. Weber called politics the slow boring of hard boards because he understood that the decisive political virtue is not intensity of belief but endurance through friction. The great danger of scale is that it allows the citizen to substitute passion about large causes for persistence about small consequences.
This may be part of what we rather lazily call political apathy. Perhaps the apathetic citizen does not care too little. Perhaps he has learned to care at the wrong scale. He knows who should be Prime Minister but not who runs the local medical centre. He can explain coalition arithmetic but cannot name the person responsible for the footpath outside the school. He follows national politics as though watching weather systems on television. Governments come and go, fronts move across the country, funding pressures gather in the west, policy settings strengthen overnight. Nobody expects to influence weather, and once politics is experienced mainly at this altitude the citizen begins to behave like a spectator even when the matter is two streets away. Kohr's complaint was not simply that big institutions are inefficient. It was that bigness alters the human imagination. It makes causation feel distant and action feel ridiculous. If the relevant object is “the health system”, what could I possibly do? If the object is “one missing doctor”, the question becomes much more annoying.
And elections intensify this habit because they become the great ritual of displaced agency. Need better healthcare? Vote correctly. Need safer roads? Vote correctly. Need cheaper electricity? Vote correctly. Need a school? Vote correctly. Need water? Vote correctly. The ballot paper begins to resemble a voucher redeemable against reality. Of course elections matter. Representative democracy matters. Governments make enormous decisions. But if voting becomes our model for citizenship itself, we quietly teach people that social causation is something delivered after an electoral transaction. You make your selection, government takes custody of the future, and then you wait. Hirschman would regard this as a tragic waste of possibility because communities are full of unused resources that disappear from view when every problem is framed as a request to an authorised centre. Someone knows somebody. Someone has a building. Someone can organise transport. Someone can raise money. Someone can produce evidence. Someone has professional credibility. Someone is stubborn enough to keep ringing. None of this appears on the institutional map because the institutional map mainly asks who has formal responsibility.
Kohr asks the ruder question: how much could be done before the responsible authority finishes its meeting? This is not an argument for abandoning the state, nor is it nostalgic village romanticism. Some problems are genuinely large. Defence is large. Monetary policy is large. Specialist medicine can be large. National regulation can be large. The mistake is not scale itself but the automatic upward movement of problems simply because an upper level exists. Subsidiarity should not be a ceremonial word placed in governance documents and then forgotten. It should be an instinct. Do not send upward what can be done beside you. Do not nationalise psychologically what remains locally tractable. Do not confuse the existence of a large cause with the impossibility of a small remedy. Modern political language loves “root causes”, and rightly so in many cases, but the root cause has become another magnificent hiding place. If everything is structural, then nothing nearby appears actionable. If the GP shortage results from decades of workforce planning, funding arrangements, demographic change and immigration settings, all of that may be true, and still somebody may be able to recruit one doctor. Why do we imagine that identifying the roots forbids us to prune the branch?
This is where the whole thing becomes slightly comic in the darkest sense. We have enlarged our conception of legitimate politics until ordinary competence looks trivial. The neighbourhood working bee is quaint. The persistent local organiser is annoying. The citizen who refuses to let an issue go is called difficult. The institutional language prefers “stakeholders”, one of those words that seems designed to remove blood circulation from human beings. A man whose children attend the school, whose parents use the medical centre, whose taxes maintain the road, whose friends live nearby and who expects to be buried in the local cemetery is not merely a stakeholder. He is part of the place. Once that thought returns, politics changes shape. The community does not ask permission to care. It investigates, organises, gathers evidence, irritates people, forms alliances, raises money where appropriate, presses institutions where necessary, cooperates when cooperation works, embarrasses them when it does not, and most importantly refuses to surrender ownership of the outcome.
Sometimes the problem will still need Wellington. Fine. Go to Wellington. But go carrying a concrete proposal, local evidence, names, commitments, numbers, perhaps even part of the solution already assembled. This is not the same as mailing the problem away. A healthy relationship between citizen and state should resemble a relay, not a surrender. The community carries the baton until it reaches something only government can do. Government does that part. Then the baton comes back. Our current civic pathology too often reverses this. We hand over the baton at the starting line and then spend three years criticising the runner.
Kohr, Hirschman, Simon, Lindblom, Popper, Oakeshott, Scott, Ostrom, Pressman, Wildavsky, Ellul, Fromm, Foucault and Weber all arrive at roughly the same uncomfortable place by different routes. Beware scale. Beware abstraction. Beware the seductive dignity of the comprehensive solution. Beware the institution that knows everything in general and almost nothing in particular. Break problems until human hands reappear. Look for openings. Trust local knowledge without romanticising it. Use government where government is necessary. Escalate only what needs escalation. Try something. Correct it. Persist. Ask where to go next. Accept responsibility for consequences rather than hiding inside convictions.
The deepest form of political control may not be telling citizens what they must do. It may be persuading them that action properly belongs somewhere else.
And so the missing rural doctor becomes almost a philosophical creature, wandering forever through our political imagination. The bureaucrat calls him workforce capacity. The party calls him policy failure. The consultant calls him a service gap. The economist calls him a supply constraint. The citizen might simply call him a doctor and ask who has his phone number.
At that moment the scale collapses, the abstractions become slightly embarrassed, and politics finally comes back down to earth where it belongs.


Once more into the breach I go. Your erudition vastly exceeds mine. Almost everybody's does. But you ask the question and my lazy mind finally came up with a possible answer. You wrote "He would ask the irritating questions. Why precisely can we not attract one doctor? Is it salary? Housing? Registration? Professional isolation? After-hours duties? The spouse cannot find work? The practice model is unattractive? The visa is uncertain? The town has no decent rental accommodation? Which one of these is actually stopping someone signing the contract? This is not glamorous politics. It is almost indecently practical."
I admit to being a thick. The answer to your question is: "All of the above". To attract a doctor (given we have over 1000 too few and pay less than Australia) we need to offer salary, housing, s/he must be registrable, accept isolation, be prepared for call-outs, be where there is work for spouse, be through the visa issue, and Uncle Tom Cobly And All.
That's exactly the problem - it is NOT some leak that can be fixed with a borrowed ladder. The town can maybe subsidise a house, even subsidise the salary, but finding solutions to the rest? Yes, we do need another medical school. Good luck to the Whykickamoocow Town Council is subsiding their way into that. No?
Gold! 10 points for Gryffindor.